Where Should I Have My Baby?

  • Reference Number: HEY-1002/2018
  • Departments: Maternity Services

Introduction

The information in this leaflet is evidence-based, and sourced from NICE (National Institute of Clinical Excellence).  NICE has used results from a number of studies to make recommendations about planning place of birth.  This includes information from a large well-conducted study in England (the Birthplace study, 2011) that recorded birth outcomes for more than 64,000 mothers and babies – the largest study of its kind in the world.

For the majority of women, pregnancy and birth is a natural life event and giving birth is generally very safe for both you and your baby, wherever you choose to have your baby.  Your choice will be a personal one based upon many factors.

At Hull and East Yorkshire Hospitals NHS Trust, our ethos is one which puts women at the centre of their own care; supporting you in making decisions about how you want to give birth whilst ensuring safe and high quality care is maintained.   As part of our maternity services we are delighted to provide you with three choices of birth environment.

It is important that you and your partner have all the information you need to make choices about where you would like to give birth. It is your choice and, even after you have decided where you want to have your baby, you can still change your mind.

Your midwife can discuss the options that are available in Hull and East Yorkshire if you have any further questions after reading this leaflet. You are also free to choose maternity services in any other area if you are willing to travel.

Please be aware we are a teaching hospital, so students may be present for your care.  If you do not wish to have students participating in your care, please tell the midwife looking after you.

What is ‘midwife-led care’?

 If you have no complications in your medical history or during any previous pregnancies or births, you will be allocated to ‘midwife- led care’ (MLC).  This means that care during your pregnancy, birth and after you have had your baby will be provided by our team of midwives in the community and in the hospital.

Women allocated to midwife-led care are suitable to have their baby at home or in our birth centre.  Studies suggest that for women with low-risk pregnancies, midwife-led care is as safe as care shared with obstetric consultants.

If any complications arise, the midwives caring for you will arrange for you to be seen by our obstetric teams (doctors specialising in pregnancy and birth).  If the problem is ongoing, you will remain under the care of the consultant (CLC) for the rest of your pregnancy and birth, working as a team with your midwives and other professionals.  If the problem is resolved the consultant will refer you back to midwife-led care.

If you are under the care of the obstetric team and you want to give birth somewhere other than the Labour Ward, we would recommend that you discuss your plan of care with a consultant obstetrician.

Home Birth

Women labour more effectively in an environment where they feel relaxed and comfortable.  For some women, the most comfortable and relaxing place will be in their own home.  If you choose to have your baby at home, a community midwife will come and care for you during your labour.  Your midwife will listen to your baby’s heart beat regularly, as well as monitoring your well-being.  A second midwife will also attend for the birth.  Your midwife will stay with you for at least two hours after you have given birth.

If you choose to hire your own birthing pool, our midwives are experienced at caring for women planning a water birth. You may also wish to consider the use of acupuncture, aromatherapy, hypnotherapy or a TENS machine; however you would need to arrange these yourself. You can use gas and air (Entonox) at home for pain relief and the midwives will bring this with them.

You need to provide very little for a home birth as almost all equipment is brought by the midwives apart from towels etc.  Your midwife will visit you at home towards the end of your pregnancy to discuss plans for your home birth in detail.

The Fatima Allam birth centre (midwife led unit)

The Fatima Allam Birth Centre is a Midwife Led Unit (MLU), within the Labour and Delivery Suite at Hull and East Yorkshire Women and Children’s Hospital, which opened in 2017.  It has three birthing rooms, which are large and homelike.  Each has a birthing pool and an en-suite shower room.  The Birth Centre is staffed by midwives and midwifery assistants.

Your midwife will listen to your baby’s heart beat regularly throughout your labour, as well as monitoring your well being.  There are many ways to help you manage your labour, including adopting different positions, use of water, mobilising, heat packs, breathing and relaxation techniques, massage and aromatherapy.  Your midwife will support you with whichever method you choose.  You may also wish to consider the use of acupuncture, hypnotherapy or a TENS machine; however you would need to arrange these yourself.  For women wanting additional pain relief, gas and air and injectable opioid pain relief (Pethidine) are available.  Women or babies needing review by doctors would be transferred on to the Labour Ward.

Two nominated birth partners (adults) can be present throughout labour and until you leave the Birth Centre.

After giving birth at the Birth Centre, you can either choose to go home 2 – 6 hours after the birth, or if you want to stay in the hospital for support with feeding etc., you will be transferred to the postnatal ward (Rowan Ward) on the first floor of the Women and Children’s Hospital, normally around 2 hours after giving birth.

For some women, care during labour and birth is more appropriately given in a consultant led setting

Labour Ward (Obstetric Unit)

The Labour Ward at Hull and East Yorkshire Women and Children’s Hospital has approximately 6000 births a year.  The Labour Ward is staffed by a team of midwives and medical staff supported by other members of the multidisciplinary team including anaesthetists, paediatricians, midwifery assistants, theatre staff and ancillary staff.

Our midwives will work with you try to keep your labour and birth as normal as possible.  There is a birthing pool on the Labour Ward which may be used by women under consultant care with the agreement of the obstetric staff.  The midwife caring for you will listen to your baby’s heart beat regularly through your labour, as well as monitoring your wellbeing.  Alternatively, it may be suggested that your baby’s heart rate should be continuously monitored through labour using electronic fetal monitoring.  It is still possible to try different positions and mobilise through your labour even if your baby has continuous monitoring, and your midwife will help you with this.

For women requiring additional pain relief, inhalation (gas and air), injectable opioid pain relief (Pethidine) and epidural anaesthesia is available.

Two nominated birth partners (adults) can be present throughout labour.  For women who have an operative birth i.e. caesarean section, one person may be present for theatre and the recovery time which is usually 4 – 6 hours.

Women giving birth on the Labour Ward are normally transferred to the postnatal ward (Rowan Ward) on the first floor of the Women and Children’s Hospital, around two hours after giving birth.  Some women may need to remain on the Labour Ward for longer postnatally if they need more specialist care.  Any special requests will need to be pre planned and pre discussed with the Labour Ward manager.

What about safety?

The Birthplace study looked in depth at outcomes in different places of birth.  The findings suggest that for women having their second or subsequent baby, it is at least as safe to have your baby at home or in an alongside midwifery unit as it is in an obstetric unit.  In addition, women planning to have their babies at home or in a midwifery led unit are significantly more likely to have a normal birth and less likely to need interventions such as a caesarean section.

For women having their first baby, the Birthplace study identified a slightly increased risk of serious complications for the baby in women planning to have their baby at home (9 in 1000) compared to women planning to have their baby in a midwifery led unit or obstetric unit (5 in 1000).  Women planning to have their first baby at home or in a midwifery led unit are more likely to have a normal birth and less likely to have interventions than women planning to have their baby in an obstetric unit.

Transfer from home or the AMLU to Labour Ward

Sometimes there might be reasons why your midwife might suggest you transfer from home or the midwife led unit to the Labour Ward. Reasons for this might include

  • Slow progress of labour
  • Concerns about your baby’s heart rate
  • Concerns about your health or wellbeing
  • If you are asking for further pain relief e.g. an epidural
  • If your baby has passed meconium during labour
  • If your placenta has not delivered
  • If you have a complicated tear which needs repair by a doctor

Transfer from a home birth would take place via ambulance.  Transfer from the AMLU to the Labour Ward would be via wheelchair or trolley.  The Fatima Allam Birth Centre is situated immediately adjacent to the Labour Ward.

Any Questions?

Please read this information leaflet and share the information it contains with your partner and family so that they can be of help and support.  There may be information they need to know, especially if they are supporting you as the birth partner(s).

Your community midwife will be happy to discuss your choice of place of birth with you at your antenatal appointments. You can get more information about labour and birth by attending Parentcraft (antenatal) classes – ask your midwife for details if you have not been given information on how to access these.  If you are considering a home birth, we also run home birth information evenings for women and their families.  These are held once a month at Beverley Children’s Centre and will give you the opportunity to discuss any questions you might have about home birth.  To book a place on a home birth evening, please contact (01482) 382742 after your 20 week scan.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact Community Midwives (01482) 382742

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.